| |
740 S Main St Cheboygan MI 49721-2220 | |
(231) 627-4361 | |
(231) 627-1323 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 740 S Main St, Cheboygan, Michigan |
Authorized Official Name and Position | Holly Campa (VICE PRESIDENT/FINANCE) |
Authorized Official Contact | 2316271203 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 419 Cheboygan MI 49721-0419 Ph: (231) 627-1438 | 740 S Main St Cheboygan MI 49721-2220 Ph: (231) 627-4361 |
NPI Number | 1821019563 |
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Provider Enumeration Date | 07/21/2006 |
Last Update Date | 12/08/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821019563 | NPI | - | NPPES |
080A610030 | Other | MI | GROUP BLUE CROSS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (Michigan) | Primary |
Leja Jackson Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 920 S Huron St, Cheboygan, MI 49721 Phone: 231-597-8192 Fax: 231-597-8463 | |